History:

A 7-year-old boy has family history of atopy (asthma and allergic rhinitis), presented with severely pruritic erythematous scaly rash on the face especially in periorificial areas (around the eyes, mouth and nose), neck, dorsa of the hands and popliteal areas. At this presentation, periorbital areas were severely affected with some crustations.  The history was characterized by remissions and exacerbations with the onset since early infancy as the father described. Large amounts of topical and systemic corticosteroids have been prescribed to the patient with temporary relief of the rash and pruritus at the expense of some Cushinoid appearance.